Anthem Blue Cross (HMO, PPO, EPO)
Rinvoq (upadacitinib)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Quantity Limit: 1 tablets per 1 day(s).
  • Step Therapy: ST Multiple Generics

  • PA Applies
  • Available only through Specialty Pharmacy;
    For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on drug coverage click  HERE;
  • Ankylosing Spondylitis (AS), Ulcerative Colitis (UC):
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    TB Test required: No

    Atopic Dermatitis (Eczema):
    Age Requirement: >= 12
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    Initial Authorization - POEM Values: N/A
    Initial Authorization - SCORAD Values: N/A
    Initial Authorization - EASI Values: N/A
    Initial Authorization - IGA Values: N/A
    Initial Authorization - PGA Values: N/A
    Initial Authorization - ISGA Values: N/A
    Initial Authorization - BSA Values: N/A
    Physician Attestation for Initiation Required: No
    Step Trial Length Period: N/A

    Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA):
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    TB Test required: Yes

  • Prior Authorization: Ankylosing Spondylitis (AS), Ulcerative Colitis (UC):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Atopic Dermatitis (Eczema):
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)
    Reauthorization Required: Yes

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